Implementation of the HUGO™ RAS system for robot-assisted radical prostatectomy: a single-center comparison with the da Vinci Xi® system

Abstract Purpose To compare early perioperative and pathological outcomes between the HUGO™ RAS and da Vinci Xi ® robotic platforms for robot-assisted radical prostatectomy (RARP) at a single center. Methods We retrospectively analyzed 107 consecutive patients who underwent RARP (50 HUGO™, 57 da Vinci™) between April 2024 and December 2025, performed by two surgeons who both used both systems. Outcome-specific propensity score models with overlap weighting were used to estimate adjusted associations between platform and operative duration, length of hospital stay, anastomotic integrity, positive surgical margins, lymph node yield, complications, and achieved nerve sparing. Results Baseline characteristics were broadly comparable, although the HUGO™ cohort included a higher proportion of high-risk D’Amico tumors. Operative duration was longer with HUGO™ in the unadjusted analysis (211 vs. 193 min, p = 0.036); after overlap weighting and covariate adjustment, the difference was 14.6 min (95% CI -3.0 to 32.2) and not statistically significant. No statistically significant adjusted differences were observed between platforms for length of hospital stay, anastomotic integrity, positive surgical margins, lymph node yield, complications, or achieved nerve sparing. Conclusion In this early single-center experience, RARP performed with the HUGO™ RAS system showed no statistically significant differences in early perioperative and pathological outcomes compared with the established da Vinci Xi ® platform after adjustment for measured confounders. Larger prospective multicenter studies with longer follow-up are needed to confirm these findings and to evaluate long-term oncological and functional outcomes.